Johnson Creek Fire EMS Dept.

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

6001180 Issued in WI

Legal business name

JOHNSON CREEK FIRE EMS DEPT.

Practice address

125 Depot St.
Johnson Creek, WI 53038-0451

Phone

(920) 699-2296

NPI assigned

Jan 3, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Paul Moderacki

Title

Village Administrator

Phone

(920) 699-2296

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Village of Johnson Creek2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Village of Johnson Creek

  dba Johnson Creek Fire & EMS Department

  • Land Ambulance
  • Johnson Creek, WI
  • NPI 1528172905
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609933001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 DEPOT ST.",
            "city": "JOHNSON CREEK",
            "state": "WI",
            "postal_code": "530380451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 DEPOT ST.",
            "city": "JOHNSON CREEK",
            "state": "WI",
            "postal_code": "530380451",
            "telephone_number": "920-699-2296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON CREEK FIRE EMS DEPT.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MODERACKI",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "VILLAGE ADMINISTRATOR",
        "authorized_official_telephone_number": "920-699-2296"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "WI",
            "license": "6001180",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41307600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Ann Hunkins, LCSW
• Cathy Ann Hunter, PA
• Johnson Creek ASC LLC
• Johnson Creek Counseling & Wellness Center LLC
• Johnson Creek Dental
• Johnson Creek School District
• Shonna Marie Jorgensen, D.D.S.
• Barbara J Kelly, OTR
• Luxottica of America Inc (Oakley B834)
• Thomas M McGorey, MD

• Land Ambulance in Johnson Creek, WI
• Providers in Johnson Creek, WI by specialty
• Land Ambulance in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.